MEDICARE: MICHELE LOIS JACOBS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	001729-1	NY

General Provider Information

NPI Number	:	1760703953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE LOIS JACOBS OTR

Provider Business Mailing Address
First Line	:	1868 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2438
Country	:	US
Telephone Number	:	718-339-7812
Fax Number	:	718-339-0428

Provider Business Practice Location Address
First Line	:	1868 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2438
Country	:	US
Telephone Number	:	718-339-7812
Fax Number	:	718-339-0428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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